Comprehensive Healthcare Staff Culture Survey

July 5, 2016

A. Sustainability Problem

Many initiatives of safety and quality improvement to prevent and control hospital-acquired infections have failed. They have been unmeasurable or have ignored clinical outcomes.

Culture often determines and limits strategic planning efforts in large complex organizations. Organizational culture enacts extreme resistance to efforts at changing policy and practice. Organizational dynamics and structures prevent improvement at multiple levels of analysis: the industry, the institution, the department. Therefore, quality and safety interventions aimed at changing collective work practices are unlikely to be sustained beyond the intervention period itself.

To get at the root of the infection issue, it is necessary to approach the culture of the hospital, on a unit-by-unit basis, to really understand what hospitals are up against in order to design and implement strategy.

B. Technology Stakeholders

C. Implementation

First: Focus on psychological processes of the individual, rather than the normative behavior of the group. Review the key psychological principles that govern the cognition and behavior of individuals.

Second: Target specific behaviors among staff by levering the survey results which provide a foundation for quality and safety interventions. A focus on the individual, rather than the group, can change patient safety behavior on the hospital’s front lines.

Third: Using the survey model, draw a broad set of theories and principles concerned with changing the behavior of the individual, rather than trying to redirect the herd. In contrast to efforts toward change directed at groups of people, individual behaviors can be highly receptive to change.

Fourth: Use the survey and assessment to highlight the challenges the individual faces to improve quality and safety and then, highlight those interventions that will be the most successful, based on the culture of the unit.

Fifth: Invite front-line staff to participate anonymously to help identify the challenges facing hospitals, to enact the change needed for improving patient safety. Invite clinical staffs to complete the Risk, Behavior and Culture Survey developed by Infonaut who built into the software an incentive feature to motivate and award stakeholders up to 1.25 hours of professional continuing education credits.

Sixth: Use the results to identify both obstacles and opportunities for introducing specific interventions on a unit-by-unit basis. The survey model serves as an instrument to learn about clinical staff perceptions of their information use habits and norms, and perceptions of patient safety and the role of management.

Seventh: Present to staff the results of these measures which act as a baseline measure for interventions targeting staff attitudes and dynamics. The survey specifically measures:

1. Unit attitudes to patient safety;

2. Unit capacity-to-learn as a group;

3. Unit information culture; and

4. Personal perception of risk.

Eighth: Follow-up retesting after a set period (i.e. a year) to determine measureable change in culture based on the effective interventions and relationships.

D. Benefits of the Technology

Infonaut is useful for solving the challenge of deadly hospital infection through their proprietary real-time surveillance, analytics and behavior improvement platform. Data sets of population health, public health, data-warehousing and privacy were referenced to develop innovative platforms that use the power of location technology, and B.I. systems for disease and infection surveillance.

“In healthcare today, the patient experience is of utmost importance. By accurately capturing where our delays were, we were able to identify our primary challenges and implement solutions to directly impact those areas.”

By: Kristen Brown, Clinical Manager of Children’s National Health System

Children’s National Health System is a pediatric care provider in Washington, D.C. For over 140 years, Children’s National has pioneered new therapies and treatments across a wide array of medical specialties, from neonatal services to cancer care.

The Children’s National Cancer Center is a very busy outpatient clinic, with 100+ providers, seeing 200+ patients each day. At Children’s National, successful cancer treatment is not just about delivering medication, but also about providing a friendly, comfortable environment where patients can feel safe for the duration of their treatment. This includes providing art and music therapy to patients while they wait.

When a child comes in for cancer treatment, the visit often is a multi-step process that takes hours. Accompanied by their parents or other caregivers, patients must sign in, give vital signs, have blood drawn, wait for lab results, see clinicians, and perhaps sit through lengthy chemotherapy infusions. There were so many moving parts going on at one time. Lab results might take an hour or two and patients would get bored and wander. Or, they might leave the unit for radiology or some ancillary service and would need to be tracked down at every turn. Children’s National spent too much time simply looking for their patients.

The excessive wait times, and a general lack of information made for a less than pleasant patient experience. The clinical processes had become inefficient and there was no data to track the patient flow to find and fix bottlenecks. Children’s National wanted to make the system more transparent to families, making it possible for everyone to know where they stood in line to be seen by their providers.

Children’s National tackled the challenges inherent in paper-based information flows—and in the process also increased its own staff efficiency. The Savance Health Staff Tracking solution was used to improve communication and workflow, and healthcare team organization. This significantly decreases patient wait times and increases patient satisfaction.

Patients (children) and their parents, other caregivers/family members

Technology Deployment:

Savance Health deployed customized solutions: Patient Self Check-In, Waiting Room Display, and Patient Tracking & Flow solutions, helping Children’s National completely transform the workflow of its cancer and blood disorders unit so that when a patient arrives at the clinic, their adult caregiver signs them in at an easy-to-use touch-screen kiosk.

Savance Health Patient Self Check-In can pull information straight from an ID card, a driver’s license, or an insurance card, and easily fill out the patient’s address, phone number, current doctor, current medications, insurance, and date of birth. The solution delivers two key benefits: accurate and complete patient information – acquired through a patient-friendly process.

Once the patient has signed in, Savance’s Patient Tracking & Flow solution takes the mystery out of clinical workflows and patient location. The software tracks where patients are at any given time, and how much time they spend in each area. A display screen in the waiting room —with patient names symbolized by pictures of animals to maintain confidentiality— tells families how many patients are ahead of them to see their specific provider.

Another screen in the clinic workroom shows where patients stand in the day’s workflow. This allows Children’s Health not only to find patients quickly without searching the building, but also to see where process breakdowns occur and take steps to increase workflow efficiency.

This report describes how Trinity Health (Trinity) and Accenture identified and remedied challenges to hospital communications, to remove impediments to care delivery in terms of both cost and quality. The case study supports enterprise-wide efforts to improve and standardize communications processes, implement business rules to prioritize communications, and make better use of technology tools that manage communications across stakeholder groups.

Failures in communication is among the top three root causes of sentinel events. A typical 500-bed acute care hospital will average an annual economic burden of about $4 million due to wasted communication time.2

Technology that was supposed to be linking people was sometimes creating redundancies, interruptions, and getting in the way of quality care delivery. One clinician might interrupt workflows by responding to every interruption immediately, while another might not respond immediately to any messages, impairing clinical decision-making and team communications.

Uncoordinated communications channels in use included landline and mobile phones, voicemail, text messages (SMS), pagers, email, patient-tracking systems, geo-location technology, digital signage, whiteboards, and even hand-carried notes. As a result, cascades of redundant messages followed clinicians to and from the office by phone, text, voicemail, and pager. Unstandardized, uncoordinated communications caused unnecessary interruptions to workflows, misidentified the priority of specific work-related information, and created negative compensatory behaviors, feedback loops, and process workarounds.

Technology Stakeholders

Trinity Health (hospital)

Doctors

Nurses

Clinicians

Administrators

Patients (residents, tourists, visitors)

Caregivers

Government

Implementation

Trinity Health worked with Accenture to plan and implement new processes and technology across their healthcare organization.3

Accenture investigated Trinity’s network to explore similarities and differences that might exist in processes, technologies, and organizational cultures between different hospital departments and their associated technology platforms.

Accenture evaluated and benchmarked communications technology and processes, developed a road map to a future strategy and used cases, and advised on technology and process reorganization to achieve Trinity’s organizational goals.

Through situational observation and shadowing of nurses, Accenture studied separate hospital facilities to identify and remove impediments to coordinated communications.

Accenture documented and analyzed the frequency and duration of communications and technology contacts, categorized the different types of contacts, and determined the impacts of these contacts on care delivery.

The resulting data was organized to expose findings related to patient safety and quality of care (e.g., turning and repositioning), hourly rounding, and patient/caregiver experiences, especially in the operating room and intensive care unit.

Clinicians and Accenture observed the wide range of information technologies that were used in uncoordinated way and identified suboptimal practices as contributing factors in the interruption of workflows, degradation of the quality of information being communicated among clinicians, and delays during unit and shift handoffs.

Accenture studies supported enterprise-wide efforts to standardize communications processes, implement business rules to prioritize communications, and make better use of technology tools that manage communications across modalities and stakeholder groups. The key benefits that Accenture and Trinity are working toward include:

Optimizing clinical workflows with improvements to cost and quality of care;

Improving the quality of hand-offs between units and shifts, with reduction in time lags and interruptions;

Streamlining and prioritizing provider workflows;

Improving patient/patient caregiver satisfaction ratings.

Trinity is taking steps at the enterprise level to empower local decision makers to streamline stakeholder communications.

The communications priorities of the organization are now under review and reorganization to facilitate better integration of communication needs at centralized and local levels. More business rules and automated technology are implemented to better manage and prioritize communications across modalities.

Trinity integrated technology into their operations and leveraged digital communications into planning for future patient satisfaction initiatives and into the architectural plans for new hospital facilities.

IoT: Public lighting is everywhere but connected lighting is not.

Sustainability Problem

Energy Efficiency

Lighting, beyond illumination, is an energy related asset. There are about 300 million street lights worldwide. On average, public lighting is more than 20 years old. Lighting can account for up to 40% of city’s total energy consumption. -1% of installed systems, are connected, expected to grow at 16% per year. Over the past year, we’ve seen IoT-enabled innovations enter our homes, cars, phones, and air space – and even appear on our bodies. Will they make our lives safer, simpler, healthier, and more environmentally responsible?

Technology Article Summary

24-May-2016

The Internet of Things: Turning $3 Lightbulbs Into A $60 Billion Opportunity1

From this article, we learn how connected public lighting can be a driver for the digital transformation of cities and join the Internet of Things (IoT) revolution. See how Dutch company Koninklijke Philips N.V. partners with SAP to empower the digital transformation of cities as they become safer and more livable and energy efficient.

The idea was a reimagined commodity that we all rely on, opening the door to a $60 billion market opportunity. Philips is refurbishing streetlights, parks, bus stops, buildings, and bridges around the world with LED lightbulbs. But these are not just standard $3 lightbulbs – they’re connected and controlled through a remote management system.

Cities can now keep their residents safer by monitoring storm drains during heavy rains. They can even adjust lighting levels to strike a balance between public safety and costs related to energy consumption and maintenance. More important, they’re making the world safer, brighter, and a little more beautiful.

To set the stage for the connected lightbulb market while helping cities and towns benefit from digital transformation, the public segment leader at Philips Lighting discussed:

Assets will need to communicate so their behavior can be flexibly adapted; therefore, verify on: How many assets are there? What state are they in? Are they working when they are supposed to or not working when they are not supposed to? How much energy do they use?

Measure the energy used while monitoring lighting as they change the behavior of the environment over time to ensure energy efficiency and right amount of light at the right place at the right time. Connect assets to be able to manage them remotely. Two trends: (1) Switch from analog to digital (LED) light points with microchip for communication, tracking and connectivity; (2) Employ business model involving third party service provider. This needs:

Connected lighting for transparency

Create proprietary networks (i.e. RF or powerline networks)

Deploy light points by embedding cellular network into the device now available publicly

Measurement and verification systems in place such as EPC (Energy Performance Contracting)

Unlock potential of IoT and think about the market opportunities in cities. More and more people will be living in cities which are close to innovation age.

Need partnership: Philips partnered with SAP to use IoT technology for better outcome. Philips focused on the potential of IoT market while SAP focused on the future of city program for innovative, smart and digital city. Both focused holistically on how city can become digital, smart, green and resilient cities because 80% of the energy consumption, as well as GDP, are generated through cities.

To be successful, keep in mind cities core functions are: 3 Ps – Protection, Proviision of Services, Prosperity. Cities must deliver value and protection is a key aspect. Cities are the heart of the challenge we face in the future.

Protection:

Looking in tech enabled value to enable value allows the understanding of how to monetize and unlock the potential of IoT in the cities market for urban resilience, and protection against climate change, terrorism, crime, shocks, etc.

Provide Services:

Look into how IoT can improve the lives of the people in those cities such as by providing waste services, safety, water, lighting, etc.

Prosperity:

For business outcome, how can IoT technology reduce risk of fire, flooding, and improving management of the infrastructure?

Some examples of implemented Philips CityTouch infrastructure:

Kristiansund in Norway has 5,500 light points and outages are fixed in no time.

Buenos Aires, has 91,000 light points, was a partnerships with Philips CityTouch and SAP Hana. Implemented by combining real time data from connected street lights with data from other assets and sensors in a single integrated city dashboard.

Empire State Building of NY changes peoples’ state of mind through color transformation lighting. On the Commencement Day of Columbia University, lighting is turned to blue and white.

Miami Tower in Florida is a business case that proves savings of $ 0.25 M per year.

Bay Bridge in San Francisco implemented responsive lighting in which pattern is connected to city rhythm, i.e. traffic, wind, and they come together in algorithm to reflect the pattern of lighting in the bridge.

In summer air-conditioning season, nothing is more divisive than when and where to set the temperature in workplaces. Some employees control the thermostat and it’s a daily battle of, “I’m cold. I’m hot. Turn it off. Turn it up.” Thermal comfort impacts worker productivity and company’s triple bottom line. New information and office productivity technologies are a driving force for innovation.

2. Technology Article Summary

An article from the Wall Street Journal: Cold War Over the Office Thermostat

People dress to stay cool on the commute but freeze inside the office. Some wear sweaters or coat at work, while others strip down to a T-shirt and sandals.

Some employees tamper with the thermostat without asking colleagues. According to a survey by the International Facility Management Association, many devise tactics to get the temperature they want inside offices.

Building managers maintain temperatures in a range between 68 and 74 degrees Fahrenheit—comfort levels for most people.

To placate complainers, some facility managers install dummy thermostats to give occupants an illusion of control, although with no connection to the air-conditioning system.

Dummy thermostats make office workers happier because of the sense of control over the temperature. Office workers perform best when they have control over their physical environment.

Many variables affect individuals’ basal body temperatures:

Different circadian rhythms

Diet and exercise

Clothing

Activity

Gender

People are using high tech approach to manage thermostat disputes:

Comfy, a smartphone app that allows occupants to request one of the following: Warm My Space, Cool My Space, or I’m Comfy. It then sends a blast of hot or cool air to their area.

View Dynamic Glass, a smart window that enables smartphone-app users to lighten or darken the shading to heat or cool the interior, without blocking the view of outdoors.

Vector Occupant, an app that allows occupants use their smartphones to register complaints about the temperature with the building’s control system.

CrowdComfort, a crowd-sourcing app that enables office occupants to send complaints via smartphone to the building manager; about 30% to 40% are from people who are either too hot or too cold.

Using CrowdComfort app, facility managers quickly adjust temperatures that are out of the target range, or fix problems.

By building a network of human sensors, CrowdComfort allows users to capture data related to the human sensory experience. With this data, people can influence comfort, safety, and operations, and collaborate to make a building’s environment more efficient and more effective.

As we continue to strive to make the world healthier and more sustainable through technology, this blog focuses on hospitals as key stakeholders who are committed to improving the healthcare environments for the benefit of patients, staff and communities. This is the impetus to expanding the implementation of LED (light-emitting diodes) lighting technology in healthcare facilities.

Healthcare facilities are one of the highest consumers of energy in commercial building types and lighting alone represents about 42% of electricity consumption. Based on Graybar case study, the economic burden of old lighting represents $8.8 billion on energy each year to meet patient needs. A 200,000 sq. ft., 50-bed hospital in the U.S. spends approximately $680,000 annually, or roughly $13,611 per bed on energy costs.1 The “Graybar Lights the Way” case study suggests that healthcare facility saves 33% by using LED lighting technology as a cost-effective solution.2

A comprehensive evaluation requires a holistic approach. An economic assessment must be integrated with environmental and social analysis before LED lighting technology can be valued as sustainable. LED life of 50,000–100,000 hours suggests cost savings as LEDs minimize lamp replacement and maintenance costs. LEDs are deemed efficient because of an extended working life, significant reduction on CO2 emissions and electricity bills.

A downstream benefit to using LED lights is that LEDs generate significantly less heat than old lighting sources, which reduces costs on cooling and adds up to considerable energy savings. According to EPA’s 2008 assessment, lighting retrofits can save as much as 30%–50% of lighting energy, plus 10%–20% of cooling energy. Retrofits generally have shorter payback times than other building system retrofits.3

The LED technology as a retrofit solution not only yields economic and environmental benefits but also fosters social well-being. Lighting impacts caregiver performance and patient care outcome. Poor lighting impacts accuracy, reaction times and even a person’s mood. Graybar study suggests that average medication dispensing error rate in healthcare facilities is 3.8%. Nurses say constant exposure to artificial light is draining. Poor lighting compromises visibility and can lead to accidents. The study indicates 99% of patients in hospitals are age 65+ and cited “an eye that is 65+ years reduces incoming light by 65%.”4 Good lighting improves mood, reduces anxiety and depression, and decreases the length of a hospital stay. It decreases the likelihood of errors, injuries and patient falls. More comfortable surroundings help make hospitals safer, improve patient outcomes and reduce potential liability.

Other stakeholders of LED lighting technology in healthcare facilities are: caregivers, nurses, patients, facilities’ staffs and hospital operations managers; the architects and engineers who design environment for patients’ comfort and health, and caregivers’ well-being and performance; the installers of LED who require technology know-how in building green hospitals. The commitment of manufacturers and supply chains that are also stakeholders is essential to support the common goal of producing environmentally safe and economically effective LED lighting products.

LED technology offers a marketing advantage to all stakeholders. As in many other facilities, healthcare with old lighting could give the perception of poorly maintained and outdated facility. This could impact the reputation of the stakeholders and the hospital organization as a whole.

To boost energy efficiency, automatic lighting controls turn lights off when space is unoccupied, and turn lights on when triggered by occupancy sensors. Lighting controls can improve energy conservation by lighting only the space needed and configured individual fixtures or lighting zones.

To support the business case, Graybar established a four-step process composed of the following:5

Graybar captures the benefits out of rebates/incentives. Graybar handles and processes the paperwork, documents ROIs and Environmental Impact Assessment reports.

For continuous improvement, additional steps 5 and 6 below are suggested for LED lighting technology implementation:

Step 5: Rate and Rank

Graybar shall employ bench-marking to evaluate hospitals’ lighting performance, then rate and rank hospitals based on their environmental, economic and societal impacts.

Step 6: Reward

Graybar can influence societal behavior to encourage less consumption on electricity and take proactive measures to conserving energy by using a reward system. Highly acclaimed publication to laud the hospitals as champions can promote sustainability. Graybar’s Green Certification Award can help maximize energy efficiency in healthcare facility.

Environmental impact and corporate social responsibility effect reputation to work to the advantage of the healthcare organizations. This affects the economic bottom line.